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The shape of things to come?

The shape of things to come?

Denplan’s Roger Matthews considers how fragmented the dental industry can become if current patterns are to continue.

Early in a New Year – as I write – is traditionally the time for looking back and predicting futures, and nowhere is this activity more visible than in UK dentistry. Ten months into the new contract, there is much debate and still much uncertainty.

So I was struck by an article1 on retailing and business which characterised two big changes going on in the ‘post-modern’ world all around us. Post-modernism was (I vaguely recall) the new vision of the future in the 1960s, when I was busy learning dental anatomy...

The first change predicted was the decline of the so-called ‘mass market’. When one mass breaks down, a new one would no longer emerge – instead there would be lots of ‘micro-markets’ which co-exist and interact.

Contemporary examples are the decline of traditional department stores and the appearance of, effectively, indoor market places where many different brands jostle side by side. Selfridges in Oxford Street is one shining success story, whilst older brands such as M&S experienced a severe drop in sales, until recently embracing the need for change with the creation of sub-brands such as Per Una. And just look at the sheer complexity of choice and cross-selling now offered in supermarkets or technology stores.

Alongside this change is the development of the consumer as ‘the artist of his own life’, as the post-modernists would say. Faced with all this choice, we each have the possibility – aided of course by the internet – to shape our own totally individual style. Fashion clothing, I am told, now has a shelf life of about six weeks!

In dentistry, the second Demos report2, published in 2000, effectively foretold this future for us too. It put forward the idea of a ‘fragmented NHS’, with local pricing and a host of niche markets all running alongside one another. Whilst dental chains have not developed as much as many thought six years ago, some existing ones have grown, while others have appeared and now any dentist can incorporate.

Salaried services, drop-in access centres, mixed practices, cosmetic dental spas and facial rejuvenation centres are all co-existing and ‘overlapping in catchment areas and client groups’ as Demos suggested. At the same time, the government insists that its (devolved) dental budget is now serving a locally-determined medical need and not ‘pandering to cosmetic aspirations’ (Demos again).

Different regions would develop different strategies – this already seems to be emerging in a broad north/south divide – and the various stakeholders (government, local health economies, dentists, plan providers and professional bodies) should wake up to the very different opportunities and threats that are emerging.

Demos concluded: ‘It is striking that, although payment systems and levels of public funding are at the heart of the issues, the most influential long-run determinants of the new settlement are probably cultural.’ How perceptive for 2000 – but have we listened to the message?